A retrospective analysis of weight changes in HIV-positive patients switching from a tenofovir disoproxil fumarate (TDF)- to a tenofovir alafenamide fumarate (TAF)-containing treatment regimen in one German university hospital in 2015–2017

Gomez, Mario; Seybold, Ulrich; Roider, Julia; Härter, Georg; Bogner, Johannes R.

doi:10.1007/s15010-018-1227-0

Cited by 90 publications

(78 citation statements)

References 14 publications

(18 reference statements)

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“…The use of TAF, approved in the US in November 2015, is rapidly increasing given the lower incidence of adverse bone and renal effects compared to TDF. Recent data from pooled clinical trials and other studies indicate that TAF use predisposes to weight gain independent of concomitant INSTI use [20,30,31]. The very low number of participants receiving TAF is both a strength and a limitation of our study.…”

Section: Discussionmentioning

confidence: 93%

Weight gain among treatment‐naïve persons with HIV starting integrase inhibitors compared to non‐nucleoside reverse transcriptase inhibitors or protease inhibitors in a large observational cohort in the United States and Canada

et al. 2020

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Introduction: Weight gain following antiretroviral therapy (ART) initiation is common, potentially predisposing some persons with HIV (PWH) to cardio-metabolic disease. We assessed relationships between ART drug class and weight change among treatment-na€ ıve PWH initiating ART in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Methods: Adult, treatment-na€ ıve PWH in NA-ACCORD initiating integrase strand transfer inhibitor (INSTI), protease inhibitor (PI) or non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based ART on/after 1 January 2007 were followed through 31 December 2016. Multivariate linear mixed effects models estimated weight up to five years after ART initiation, adjusting for age, sex, race, cohort site, HIV acquisition mode, treatment year, and baseline weight, plasma HIV-1 RNA level and CD4 + cell count. Due to shorter follow-up for PWH receiving newer INSTI drugs, weights for specific INSTIs were estimated at two years. Secondary analyses using logistic regression and all covariates from primary analyses assessed factors associated with >10% weight gain at two and five years. Results: Among 22,972 participants, 87% were male, and 41% were white. 49% started NNRTI-, 31% started PI-and 20% started INSTI-based regimens (1624 raltegravir (RAL), 2085 elvitegravir (EVG) and 929 dolutegravir (DTG)). PWH starting INSTI-based regimens had mean estimated five-year weight change of +5.9kg, compared to +3.7kg for NNRTI and +5.5kg for PI. Among PWH starting INSTI drugs, mean estimated two-year weight change was +7.2kg for DTG, +5.8kg for RAL and +4.1kg for EVG. Women, persons with lower baseline CD4 + cell counts, and those initiating INSTI-based regimens had higher odds of >10% body weight increase at two years (adjusted odds ratio = 1.37, 95% confidence interval: 1.20 to 1.56 vs. NNRTI). Conclusions: PWH initiating INSTI-based regimens gained, on average, more weight compared to NNRTI-based regimens. This phenomenon may reflect heterogeneous effects of ART agents on body weight regulation that require further exploration.

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Section: Discussionmentioning

confidence: 93%

Weight gain among treatment‐naïve persons with HIV starting integrase inhibitors compared to non‐nucleoside reverse transcriptase inhibitors or protease inhibitors in a large observational cohort in the United States and Canada

et al. 2020

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“…The impact of these changes on atherosclerotic cardiovascular disease (ASCVD) risk is unclear [6]. In addition, recent studies suggest that initiating TAF alongside an integrase inhibitor in treatment-naive patients or switching from TDF to TAF in treatment-experienced patients can lead to weight gain [7, 8]. Patients in the switch study often had changes in other ART regimen components, thereby confounding the ability to analyze TAF alone [7].…”

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confidence: 99%

“…In addition, recent studies suggest that initiating TAF alongside an integrase inhibitor in treatment-naive patients or switching from TDF to TAF in treatment-experienced patients can lead to weight gain [7, 8]. Patients in the switch study often had changes in other ART regimen components, thereby confounding the ability to analyze TAF alone [7]. The purpose of this study was to determine whether changes in weight, body mass index (BMI), and ASCVD risk score occur after switching from TDF to TAF, without switching other ART regimen components.…”

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confidence: 99%

Changes in Body Mass Index and Atherosclerotic Disease Risk Score After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide

Schafer

Sassa

O'Connor

et al. 2019

Open Forum Infectious Diseases

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Background Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) containing antiretroviral therapy (ART) can improve renal function and bone mineral density in people with HIV (PWH). The switch can also negatively influence cholesterol, but changes in body mass index (BMI), and atherosclerotic cardiovascular disease (ASCVD) risk are unknown. Setting An urban, academic medical center Methods This retrospective observational study evaluated BMI and ASCVD risk score changes in virologically suppressed PWH who switched from TDF to TAF without switching other ART regimen components. Adults on TDF for ≥ 1 year with two consecutive HIV RNA values <200 copies/mL prior to a TAF switch were included. Body weight, BMI, cholesterol and ASCVD risk score were collected for the year prior to and following the switch. Pre and post switch values were compared with the Wilcoxon signed-rank test. Changes in BMI and ASCVD scores were modeled using generalized estimating equations regression. Results 110 patients were included. In unadjusted analyses, there were significant increases in weight, BMI, total cholesterol, LDL, HDL, and ASCVD risk score in the year after switching from TDF to TAF (each p ≤ 0.01). In regression models, switching from TDF to TAF was associated with a 0.45 kg/m2 increase in BMI (95% CI: 0.14, 0.76) and a 13% increase in ASCVD risk score (95% CI: 4%, 23%). Conclusion We observed significant BMI and ASCVD score increases in PWH one year after switching from TDF to TAF. The mechanism of changes is unclear and requires additional study.

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“…This risk of weight gain from tenofovir prodrugs may actually be higher with TAF, as evidenced in a retrospective analysis of weight changes in PLWH who were switched from one formulation to the other. After 360 days of initiating TAF, patients showed a mean percentage weight change of +3.2% compared with +0.6% for those continuing on TDF …”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Weight‐Loss Pharmacotherapy in Persons Living with HIV: A Review of the Literature and Potential Drug‐Drug Interactions with Antiretroviral Therapy

Cope¹,

Fischetti²,

Kavanagh

et al. 2019

Pharmacotherapy

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The prevalence of obesity among persons living with human immunodeficiency virus (HIV) has increased significantly and may be linked to the use of antiretroviral therapy. Although weight‐loss medications approved by the U.S. Food and Drug Administration are recommended as an adjunct to diet and exercise to treat obesity in the general population, little is known about the safety and efficacy of these drugs specifically in persons living with HIV. We review the available evidence regarding the effective use of weight‐loss pharmacotherapy in persons living with HIV and its potential to interact with antiretroviral therapy. Persons living with HIV are frequently not reported or included in clinical trials for weight‐loss medications; however, treatment efficacy is likely similar to the general population. Several important reported or theoretical drug‐drug interactions exist between antiobesity pharmacotherapy and antiretroviral therapy. Orlistat is a weight‐loss drug available in the United States without a prescription and was linked to HIV viral rebound in several case reports. Clinicians should be aware of the potential for loss of HIV viremia control when certain weight‐loss pharmacotherapies are used in combination with antiretrovirals.

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A retrospective analysis of weight changes in HIV-positive patients switching from a tenofovir disoproxil fumarate (TDF)- to a tenofovir alafenamide fumarate (TAF)-containing treatment regimen in one German university hospital in 2015–2017

Cited by 90 publications

References 14 publications

Weight gain among treatment‐naïve persons with HIV starting integrase inhibitors compared to non‐nucleoside reverse transcriptase inhibitors or protease inhibitors in a large observational cohort in the United States and Canada

Weight gain among treatment‐naïve persons with HIV starting integrase inhibitors compared to non‐nucleoside reverse transcriptase inhibitors or protease inhibitors in a large observational cohort in the United States and Canada

Changes in Body Mass Index and Atherosclerotic Disease Risk Score After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide

Safety and Efficacy of Weight‐Loss Pharmacotherapy in Persons Living with HIV: A Review of the Literature and Potential Drug‐Drug Interactions with Antiretroviral Therapy

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